Medical management of the acute radiation syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group

Jamie K. Waselenko, Thomas J. MacVittie, William F. Blakely, Nicki Pesik, Albert L. Wiley, William E. Dickerson, Horace Tsu, Dennis L. Confer, C. Norman Coleman, Thomas Seed, Patrick Lowry, James O. Armitage, Nicholas Dainiak

Research output: Contribution to journalReview article

467 Citations (Scopus)

Abstract

Physicians, hospitals, and other health care facilities will assume the responsibility for aiding individuals injured by a terrorist act involving radioactive material. Scenarios have been developed for such acts that include a range of exposures resulting in few to many casualties. This consensus document was developed by the Strategic National Stockpile Radiation Working Group to provide a framework for physicians in internal medicine and the medical subspecialties to evaluate and manage large-scale radiation injuries. Individual radiation dose is assessed by determining the time to onset and severity of nausea and vomiting, decline in absolute lymphocyte count over several hours or days after exposure, and appearance of chromosome aberrations (including dicentrics and ring forms) in peripheral blood lymphocytes. Documentation of clinical signs and symptoms (affecting the hematopoietic, gastrointestinal, cerebrovascular, and cutaneous systems) over time is essential for triage of victims, selection of therapy, and assignment of prognosis. Recommendations based on radiation dose and physiologic response are made for treatment of the hematopoietic syndrome. Therapy includes treatment with hematopoietic cytokines; blood transfusion; and, in selected cases, stem-cell transplantation. Additional medical management based on the evolution of clinical signs and symptoms includes the use of antimicrobial agents (quinolones, antiviral therapy, and antifungal agents), antiemetic agents, and analgesic agents. Because of the strong psychological impact of a possible radiation exposure, psychosocial support will be required for those exposed, regardless of the dose, as well as for family and friends. Treatment of pregnant women must account for risk to the fetus. For terrorist or accidental events involving exposure to radioiodines, prophylaxis against malignant disease of the thyroid is also recommended, particularly for children and adolescents.

Original languageEnglish (US)
Pages (from-to)1037-1051+I-52
JournalAnnals of internal medicine
Volume140
Issue number12
DOIs
StatePublished - Jun 15 2004

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Strategic Stockpile
Acute Radiation Syndrome
Radiation
Signs and Symptoms
Therapeutics
Physicians
Radiation Injuries
Antiemetics
Triage
Antifungal Agents
Health Facilities
Quinolones
Thyroid Diseases
Lymphocyte Count
Stem Cell Transplantation
Internal Medicine
Anti-Infective Agents
Chromosome Aberrations
Blood Transfusion
Documentation

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Waselenko, J. K., MacVittie, T. J., Blakely, W. F., Pesik, N., Wiley, A. L., Dickerson, W. E., ... Dainiak, N. (2004). Medical management of the acute radiation syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group. Annals of internal medicine, 140(12), 1037-1051+I-52. https://doi.org/10.7326/0003-4819-140-12-200406150-00015

Medical management of the acute radiation syndrome : Recommendations of the Strategic National Stockpile Radiation Working Group. / Waselenko, Jamie K.; MacVittie, Thomas J.; Blakely, William F.; Pesik, Nicki; Wiley, Albert L.; Dickerson, William E.; Tsu, Horace; Confer, Dennis L.; Coleman, C. Norman; Seed, Thomas; Lowry, Patrick; Armitage, James O.; Dainiak, Nicholas.

In: Annals of internal medicine, Vol. 140, No. 12, 15.06.2004, p. 1037-1051+I-52.

Research output: Contribution to journalReview article

Waselenko, JK, MacVittie, TJ, Blakely, WF, Pesik, N, Wiley, AL, Dickerson, WE, Tsu, H, Confer, DL, Coleman, CN, Seed, T, Lowry, P, Armitage, JO & Dainiak, N 2004, 'Medical management of the acute radiation syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group', Annals of internal medicine, vol. 140, no. 12, pp. 1037-1051+I-52. https://doi.org/10.7326/0003-4819-140-12-200406150-00015
Waselenko, Jamie K. ; MacVittie, Thomas J. ; Blakely, William F. ; Pesik, Nicki ; Wiley, Albert L. ; Dickerson, William E. ; Tsu, Horace ; Confer, Dennis L. ; Coleman, C. Norman ; Seed, Thomas ; Lowry, Patrick ; Armitage, James O. ; Dainiak, Nicholas. / Medical management of the acute radiation syndrome : Recommendations of the Strategic National Stockpile Radiation Working Group. In: Annals of internal medicine. 2004 ; Vol. 140, No. 12. pp. 1037-1051+I-52.
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